Hyperhidrosis is a medical condition characterized by excessive sweating, which goes beyond the amount needed for the body to regulate its temperature. While various treatments exist to manage hyperhidrosis, surgery can be considered an option for severe cases when other methods have not provided sufficient relief. This article explains what hyperhidrosis surgery involves, detailing the types of procedures, the patient’s experience, and important post-surgical considerations.
Understanding Hyperhidrosis
Hyperhidrosis involves overactive sweat glands, leading to sweating that exceeds physiological requirements. This condition can affect specific areas of the body, such as the armpits, palms of the hands, soles of the feet, and the face, or it can be more generalized, impacting the entire body. There are two main types: primary focal hyperhidrosis and secondary generalized hyperhidrosis. Primary focal hyperhidrosis typically starts in childhood or adolescence and is often inherited, without an identifiable medical cause.
Secondary generalized hyperhidrosis is usually caused by an underlying medical condition or can be a side effect of certain medications. Conditions such as diabetes, thyroid problems, and some neurological disorders can contribute to this type of excessive sweating. The impact of hyperhidrosis on an individual’s quality of life can be substantial, affecting emotional well-being, interpersonal relationships, and daily activities.
Surgical Interventions for Hyperhidrosis
Surgical interventions offer a permanent solution for severe hyperhidrosis when other treatments have failed. These procedures typically aim to either interrupt the nerve signals that stimulate sweat production or remove the sweat glands directly. Each surgical approach targets specific areas of the body where excessive sweating occurs.
Endoscopic Thoracic Sympathectomy (ETS)
Endoscopic Thoracic Sympathectomy (ETS) is a procedure performed to interrupt sympathetic nerves responsible for sweat production, commonly targeting the palms, armpits, and sometimes the face. This minimally invasive keyhole surgery involves making small incisions, usually under the armpit, to insert a camera and instruments into the chest cavity. The surgeon then cuts or clips the specific nerves, often at the T2, T3, and/or T4 spinal cord levels, to prevent signals from reaching the overactive sweat glands. This procedure is considered permanent.
Local Surgical Excision
Local surgical excision is another method primarily used for excessive sweating in the armpits (axillary hyperhidrosis). This procedure involves surgically cutting out the sweat glands from the affected area. While effective, extensive excision is generally not recommended due to the potential for significant scarring and limitations in arm movement.
Liposuction or Curettage
Liposuction or curettage are also utilized for axillary hyperhidrosis, offering less invasive alternatives to traditional excision. During these procedures, a small cannula is inserted under the skin to either scrape out (curettage) or suction away (liposuction) the sweat glands. These methods physically disrupt or remove the sweat glands, leading to a significant reduction in sweat production in the treated area. Results are generally permanent.
The Surgical Experience
Deciding on hyperhidrosis surgery involves a thorough evaluation process to determine if it is the appropriate treatment option. Surgery is typically recommended only after less invasive treatments, such as antiperspirants, oral medications, or botulinum toxin injections, have been ineffective. Patient suitability is assessed based on the severity and location of sweating, as well as overall health.
The surgical procedures for hyperhidrosis are performed under general anesthesia, ensuring the patient is asleep and pain-free throughout the operation. ETS typically takes about 40 minutes to an hour. For local procedures like liposuction or curettage, the duration can be between 60 to 90 minutes. Most patients are able to go home on the same day or after a short overnight stay in the hospital.
Immediately after surgery, patients can expect some discomfort or pain at the incision sites, which can be managed with pain medication. For ETS, some chest discomfort may also be present for a few days. Wound care instructions are provided to promote healing and prevent infection. The typical recovery period before resuming normal activities can range from a few days to about a week. Full healing can take weeks or months.
Post-Surgical Considerations
The effectiveness of hyperhidrosis surgery in reducing excessive sweating varies depending on the specific procedure and the targeted body area. ETS generally boasts high success rates, often exceeding 95% for palmar and facial hyperhidrosis, and around 66% for armpit sweating. Local procedures like liposuction and curettage for axillary hyperhidrosis also show high rates of patient satisfaction and significant sweat reduction. These results are typically permanent.
Despite the high success rates in reducing sweating in the primary affected areas, hyperhidrosis surgery carries potential risks and side effects. One of the most common and significant risks, particularly with ETS, is compensatory sweating. This phenomenon involves increased sweating in other areas of the body, such as the back, chest, abdomen, or legs, as the body attempts to regulate its temperature through alternative sites. Compensatory sweating can occur in a high percentage of ETS patients and can sometimes be more severe than the original condition.
While some mild cases may improve over time, severe compensatory sweating can be distressing and affect daily life. Other potential risks across different hyperhidrosis surgeries include infection, bleeding, and scarring at the incision sites. Nerve damage, though rare, can also occur, and in the case of ETS, this might lead to conditions like Horner’s syndrome. Recurrence of sweating, though less common, is another possibility. Some patients may also experience dry skin in the treated area or, in rare instances, gustatory sweating. Given these considerations, a thorough discussion with a qualified medical professional is important to understand all potential benefits and risks before making a decision about hyperhidrosis surgery.